Kacie Wallace Gonzales

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14298 Issued in TX

Practice address

2215 E Villa Maria Rd Ste 110
Bryan, TX 77802-2585

Phone

(979) 776-2000

Fax

(866) 733-2572

NPI assigned

Apr 10, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI St Joseph Health Regional Hospital Hospital, Bryan, TX, CCN 450011

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brazos Valley Hematology Oncology Associates, PA

  • Hematology & Oncology Physician
  • Bryan, TX
  • NPI 1376594432

  TX

  Medicare reassignment NPD
• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1801869250

  OK

  Medicare reassignment NPD
• Ou Health Partners, Inc

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1528642642

  OK

  Medicare reassignment
• The University of Texas Southwestern Medical Center at Dallas

  • Clinical Medical Laboratory
  • Dallas, TX
  • NPI 1396832713
  NPD
• University of Texas Southwestern Medical Center at Dallas

  • Diagnostic Radiology Physician
  • Dallas, TX
  • NPI 1972579365
  NPD
• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Edmond, OK
  • NPI 1124646971
  NPD
• Ou Health Partners, Inc

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1447834460
  NPD
• Brazos Valley Hematology Oncology Associates, PA

  • Community/Retail Pharmacy
  • College Station, TX
  • NPI 1952920076
  NPD (past)
• Jackson County Memorial Hospital Authority

  • General Acute Care Hospital
  • Altus, OK
  • NPI 1093763781
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Joseph Regional Health Center

  • General Acute Care Hospital
  • Bryan, TX
  • NPI 1942294939

  Hospital

  Care Compare affiliation
• St. Joseph Regional Health Center

  • General Acute Care Hospital
  • College Station, TX
  • NPI 1053963009

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1649899600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 E VILLA MARIA RD STE 110",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022585",
            "telephone_number": "979-776-2000",
            "fax_number": "866-733-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 E VILLA MARIA RD STE 110",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022585",
            "telephone_number": "979-776-2000",
            "fax_number": "866-733-2572"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2435 Harvey Mitchell Parkway South",
            "address_purpose": "LOCATION",
            "city": "College Station",
            "state": "TX",
            "postal_code": "77845",
            "country_code": "US",
            "telephone_number": "979-776-2000",
            "fax_number": "866-733-2572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "KACIE",
        "middle_name": "WALLACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-10",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "3181",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "14298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Douglas Goble, M.D.
• Jeffrey Dean Goddard, MD
• Goldstar Healthcare LLC
• Garrett Gomez, MD
• Rolando Gonzales Gomez Jr., PA-C
• Abbie Sue Gonzalez, RN
• Alexia Gonzalez, M.A, LPC
• Grantlan Layton Goodale, PHARMD, RPH
• Jennifer Ann Goode
• Takayius Gooden

• Physician Assistant in Bryan, TX
• Providers in Bryan, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.